JP2012505062A - Single port access system - Google Patents

Abstract

An embodiment of a surgical access system useful for single or limited port surgery includes a trocar (1810), a retractor, and a gel cap removably coupled to the retractor. 1800). The gel cap includes a gel pad that functions as an artificial body wall through which an instrument can be inserted into a body cavity either directly or through one or more trocars. The fixation cannula includes a retainer (1830) and a bolster (1840) that cooperate to capture the artificial wall therebetween to secure the trocar to the artificial wall. The gel pad allows flexible instrument placement while maintaining a hermetic seal, as well as freedom of translation and angular freedom of the instrument.
[Selection] Figures 14A and 14B

Description

[Cross-reference with related applications]
This application claims the benefit of US Patent Application No. 61 / 104,963, filed Oct. 13, 2008, the entire disclosure of which is incorporated herein by reference.

  This application relates generally to surgical devices, and more particularly to a single port laparoscopic access system.

  In surgery, access devices are commonly used to facilitate the introduction of various surgical instruments into the body's natural biological blood vessels, grooves, openings, cavities and other internal regions. These access devices include, for example, devices that facilitate the introduction of needles into blood vessels and trocars that facilitate the introduction of laparoscopic instruments into the abdomen of the human body.

  Some of these access devices are introduced into an area containing fluid or gas under pressure. In the case of a needle access device, liquids such as blood can cause pressure. In the case of a trocar, a gas such as a vent gas can cause pressure. In any case, it is desirable to introduce the surgical instrument into the cavity without leaking pressurized fluid or gas.

  In the case of a trocar, typically a cannula at the distal end of the trocar is connected to a seal housing at the proximal end of the trocar. The cannula and housing cooperate to form a working channel through which various instruments can be inserted to access the cavity. Typically, a sealing mechanism is disposed within the housing and includes a diaphragm valve that closes the working channel when the instrument is in place and a zero-closure valve that closes the working channel when the instrument is removed.

US Patent Publication No. 2007 / 0088204A1 US Patent Publication No. 2006 / 0149137A1 US patent application Ser. No. 10 / 381,220 US patent application Ser. No. 11 / 677,994

  Current surgical access ports allow for single instrument access through individual ports, or multiple instrument access through rigid cannulas. Some devices, such as a transanal endoscopic microsurgery (TEMS) unit, require the instrument to be installed through a fixed point located on the device, and the device must be installed to support the weight of the device. In addition to being mounted on the operating table, it is also necessary to position the device relative to the patient. These devices do not provide the surgeon the flexibility to select the size of the instrument and limit the movement of the instrument with the rigid cannula. Moreover, surgeons perform laparoscopic surgery through a single or limited number of access ports. In these procedures, the surgeon places multiple instruments through a single or limited number of access ports. Surgery can also be performed through a single 2 centimeter incision in the navel or, in certain cases, transvaginally or transanally. There is a need for a system that meets these new surgical needs and allows more options for the surgeon.

  An embodiment of a surgical access system useful for single or limited port surgery includes a trocar that includes a fixed cannula, a retractor, and a gel cap removably coupled to the retractor. The gel cap includes a gel pad that functions as an artificial body wall through which an instrument can be inserted into a body cavity either directly or through one or more trocars. The fixation cannula includes a retainer and a bolster that together secure the trocar to the artificial wall by capturing the artificial wall between them. The gel pad allows for flexible instrument placement, as well as translation and angular freedom of the instrument while maintaining a hermetic seal.

  In some embodiments, a surgical access system and method of using the system are provided. Embodiments of the access system include a trocar, which includes a tubular cannula body including a proximal end, a distal end, and a longitudinal axis extending from the proximal end to the distal end, and a cannula wall defining a cannula lumen. A locking cannula; a seal assembly coupled to the proximal end of the cannula body; a retainer extending from the cannula body; a locking part disposed on the cannula body and spaced from the retainer; and engageable with the locking part Including bolster. The trocar has an insertion configuration in which the bolster is not engaged with the locking component, and a fixed configuration in which the bolster is engaged with the locking component. In the fixed configuration, the retainer and the bolster have an artificial body wall interposed therebetween. By capturing, the cannula is sized and configured to secure to the prosthesis wall.

  In some embodiments, the trocar is a 5 mm trocar.

  In some embodiments, the cannula includes at least one of polycarbonate and polyester.

  In some embodiments, the seal assembly includes a diaphragm valve and a duckbill valve.

  In some embodiments, a retainer is disposed at the distal end of the cannula body and a locking component is proximate to the retainer. In some embodiments, the retainer includes a radially extending flange. In some embodiments, the diameter of the retainer flange is about 1.5 to about 2.5 times larger than the outer diameter of the cannula body. In some embodiments, the distal end of the retainer is tapered.

  In some embodiments, the locking component includes an enlarged portion.

  In some embodiments, the locking component includes a circumferential lip. In some embodiments, the locking component includes a thread. In some embodiments, the locking component includes a plurality of circumferential slots. In some embodiments, the locking component includes a ratchet.

  In some embodiments, the bolster comprises an elastomeric material. In some embodiments, the bolster includes a torus, and the cannula body extends through an opening in the torus. In some embodiments, the bolster includes a thread. In some embodiments, the bolster includes at least one pawl dimensioned to engage the ratchet on the locking component. In some embodiments, the bolster includes a clip sized to engage the locking component. In some embodiments, the diameter of the bolster is about 0.8 to about 2 times the diameter of the flange.

  In some embodiments, the locking component resists bolster disengagement in a fixed configuration. In some embodiments, the distance between the retainer and the bolster is adjustable in a fixed configuration.

  Some embodiments further include an obturator.

  Some embodiments further include an artificial body wall. In some embodiments, the artificial wall includes a gel pad. In some embodiments, the gel cap is defined by bonding the gel pad to the cap ring. Some embodiments further include an adjustable retractor that can be coupled to the gel cap.

  Some embodiments of the method include a method of securing a trocar including a fixation cannula to an artificial wall. The method includes the steps of switching the trocar to an insertion configuration, inserting the distal end of the cannula body through an artificial body wall, and switching the trocar to a fixed configuration by engaging a bolster with a locking component. And capturing the artificial body wall between the bolsters.

  Some embodiments further include inserting an obturator through the trocar.

  Some embodiments further include adjusting the distance between the bolster and the retainer in a fixed configuration.

  Some embodiments provide a surgical access system, the surgical access system comprising an adjustable retractor, a gel cap, and a trocar, wherein the retractor includes a proximal ring, a distal ring, A flexible tubular retractor sheath extending between the proximal ring and the distal ring, the proximal ring being rotatable about the annular axis of the ring so that the length of the retractor sheath is proximal The gel cap is adjusted between the ring and the distal ring, the gel cap includes a cap ring engageable with the proximal ring, and a gel pad coupled to the cap ring, the trocar having a proximal end, a distal end, and A stationary cannula body including a tubular cannula body including a longitudinal axis extending from the proximal end to the distal end, a cannula wall defining a cannula lumen, and a seal assembly coupled to the proximal end of the cannula body Comprising a Li, and a retainer extending from the cannula body, a locking part which is spaced from the retainer is disposed on the cannula body and a engageable with the locking parts bolster. The trocar has an insertion configuration in which the bolster is not engaged with the locking component and a fixed configuration in which the bolster is engaged with the locking component, in which the retainer and bolster capture the gel pad therebetween. Is dimensioned and configured to secure the cannula to the gel pad.

  Accordingly, some embodiments provide for a surgical procedure suitable for performing laparoscopic surgery at a single access site with an incision in the abdominal wall of the patient and pressurizing the abdominal cavity with insufflation gas. A surgical access port adapted to retain intra-abdominal air pressure while providing access to the abdominal cavity, the surgical access port including an adjustable retractor and a gel cap, the retractor comprising: A proximal ring disposed proximate to the outer surface of the patient's abdominal wall and configured to substantially surround the incision; a tubular wall; a proximal portion coupled to the proximal ring in use; and a distal portion A retractable sheath disposed through the incision, configured to line the incision, adjustable to retract the incision, and coupled to a distal portion of the retracting sheath and disposed proximate to the inner surface of the abdominal wall The incision being substantially A gel ring, wherein the gel cap is configured to be coupled to the proximal ring and configured to substantially surround the incision, and disposed within the cap ring. And a plurality of seal valves operably attached to the gel pad, the plurality of seal valves at least partially forming a plurality of access channels through the gel pad and sealing with an instrument extending through the seal valve And is configured to form a seal when there is no instrument extending through the seal valve.

  In some embodiments, at least a portion of at least one of the seal valves defines an orifice. In some embodiments, at least a portion of at least one of the seal valves includes a septum seal. In some embodiments, at least a portion of at least one of the seal valves includes a duckbill valve. In some embodiments, at least one of the seal valves has a low profile. In some embodiments, at least one of the seal valves has a first size for accommodating a first size instrument, and at least one of the seal valves accommodates a second size instrument. For having a second size.

  In some embodiments, at least one of the seal valves is configured to be repositionable with respect to the cap ring in use. In some embodiments, at least one of the seal valves is configured to translate relative to the cap ring in use. In some embodiments, at least one of the seal valves is configured to be pivotable relative to the cap ring in use. In some embodiments, at least one of the seal valves is configured to be loosely secured to the cap ring in use.

  In some embodiments, the gel cap is configured to be removably coupled to the proximal ring in use. In some embodiments, the gel cap is secured to the proximal ring.

  In some embodiments, the retractor proximal ring rotates in use to adjustably retract the incision. In some embodiments, the retracting sheath extends to adjustably open the incision in use.

  Some embodiments further include a tether coupled to the distal ring. In some embodiments, at least a portion of the distal ring has a non-circular cross section that facilitates folding the distal ring to insert through the incision. In some embodiments, the distal ring has a teardrop-shaped cross-section that folds the distal ring and facilitates insertion through the incision. In some embodiments, the distal ring includes at least one notch that folds the distal ring to facilitate insertion through the incision.

  Some embodiments maintain air pressure within the body cavity while providing access to the body cavity for surgery, suitable for performing surgery at the access site with the patient's body cavity pressurized with air delivery gas A surgical access port adapted to include an adjustable retractor and a seal cap, the retractor being disposed proximate to the outer surface of the patient's abdominal wall to provide an incision. Positioned through an opening in the patient's body wall, including a proximal ring configured to substantially surround and a tubular wall, a proximal portion coupled to the proximal ring in use, and a distal portion A retractable sheath that is adjustable to retract the incision, and is coupled to the distal portion of the retractable sheath, disposed adjacent to the inner surface of the abdominal wall, and configured to substantially surround the incision Including a distal ring, The cap is configured to be coupled to the proximal ring and substantially surrounds the flexible material disposed therein, and is disposed within the cap ring and substantially surrounded by the flexible material. And a seal valve operably attached thereto, the seal valve at least partially forming an access channel through the flexible material, forming a seal with an instrument extending through the seal valve, and through the seal valve It is configured to form a seal in the absence of an extending instrument.

  In some embodiments, the flexible material comprises a gel.

  In some embodiments, the seal valve can be repositioned relative to the cap ring in use. In some embodiments, the seal valve can be translated with respect to the cap ring in use. In some embodiments, the seal valve can be pivoted relative to the cap ring in use.

  In some embodiments, the seal cap includes a plurality of seal valves disposed within the cap ring and substantially surrounded by the flexible material, wherein the plurality of seal valves are configured through the flexible material. The access channel is configured to at least partially form a seal with an instrument extending through the seal valve and to form a seal when no instrument extends through the seal valve.

  Some embodiments further include a tether coupled to the distal ring. In some embodiments, at least a portion of the distal ring has a non-circular cross section that facilitates folding the distal ring to insert through the incision.

  Some embodiments provide access to the abdominal cavity for surgery, suitable for performing laparoscopic surgery at the access site with an incision in the abdominal wall of the patient and pressurizing the abdominal cavity with insufflation gas. A surgical access port adapted to retain intra-abdominal air pressure while being provided, the surgical access port configured to be positioned proximate to an outer surface of a patient's abdominal wall And an adjustable retractor having a distal ring configured to be disposed proximate to the inner surface of the abdominal wall and a retracting sheath extending between the proximal ring and the distal ring, the retracting sheath comprising: A tubular wall having a proximal portion coupled to the proximal ring for use and a distal portion coupled to the distal ring during use and configured to be disposed through the incision and line the incision To open the incision The adjustable and surgical access port further includes a seal cap including a plurality of seal valves configured to be coupled to the proximal ring in use, the plurality of seal valves extending through the seal cap. At least partially forming a seal with an instrument extending through the seal valve and forming a seal in the absence of an instrument extending through the seal valve, and in use, at least one of the seal valves Can be rearranged relative to at least another seal valve of the seal valve.

  In some embodiments, the seal cap includes a gel.

  In some embodiments, at least one repositionable seal valve can be translated relative to at least another seal valve of the seal valve. In some embodiments, at least one repositionable seal valve can pivot relative to at least another seal valve of the seal valve.

  Some embodiments further include a tether coupled to the distal ring. In some embodiments, at least a portion of the distal ring has a non-circular cross section that facilitates folding the distal ring to insert through the incision.

  Some embodiments provide an access device system that includes a retractor and a gel cap. The retractor includes an inner ring, an outer ring, and a flexible sleeve that extends between the inner ring and the outer ring. The outer ring includes an outer part and an inner part, the inner part defining an annular axis about which the outer part can be rotated so that the flexible sleeve is wound and unwound around the annular axis. The gel cap includes an annular cap ring coupled to the outer ring of the retractor and a gel pad disposed within and coupled to the annular cap ring. The gel pad does not include an access channel preformed through the gel pad.

  Some embodiments provide an access device system that includes a retractor and a gel cap. The retractor includes an inner ring, an outer ring, and a flexible sleeve that extends between the inner ring and the outer ring. The outer ring includes an outer part and an inner part, the inner part defining an annular axis about which the outer part can be rotated so that the flexible sleeve is wound and unwound around the annular axis. The gel cap includes an annular cap ring coupled to the outer ring of the retractor and a gel pad disposed within and coupled to the annular cap ring. Within the gel pad, at least one access port including a first seal and a second seal is at least partially embedded, the first seal includes an instrument seal and the second seal includes a zero seal.

  Some embodiments of the access device system include a longitudinal axis that defines an access channel, a proximal end, a distal end, a tubular cannula, a seal assembly disposed at the proximal end of the cannula, and a distal end of the cannula. A trocar including a retainer disposed at the end is further included. The seal assembly includes an instrument seal and a zero seal. The proximal end of the retainer includes a surface that is substantially perpendicular to the longitudinal axis. The diameter of the retainer convergently tapers from the proximal end to the distal end of the retainer.

  Some embodiments provide a single port access device system that includes a retractor and an artificial wall that can be coupled to the retractor, the artificial wall being dimensioned to allow access to the instrument through the interior. An instrument that includes a plurality of defined and configured access channels and is inserted through the access channel is relatively translatable and pivotable.

1 is a side view of a patient during surgery showing an embodiment of an access device placed on the abdomen and in use. FIG. FIG. 6 is a cross-sectional side view illustrating an embodiment of an access device with a retractor retracting a patient's vagina and a gel cap closing an opening of the retractor. FIG. 3 shows an embodiment of an access device placed in use in a patient's mouth. FIG. 6 is a plan view of a patient in a prone position with an embodiment of an access device placed in use in the patient's anus. 1 is a perspective view of an embodiment of an access device including a cap and retractor. FIG. FIG. 6 is a partial side cross-sectional view of an embodiment of a retractor. FIG. 6 is a cross-sectional view of an embodiment of an inner ring. FIG. 6 is a cross-sectional view of an embodiment of an inner ring. FIG. 6 is a cross-sectional view of an embodiment of an inner ring. FIG. 6 is a partial side cross-sectional view of another embodiment of a retractor. 1 is a side view of an embodiment of a retractor that includes a tether. FIG. It is a side view of the method of removing the retractor shown to FIG. 8A. 1 is a side view of an embodiment of a retractor insertion / removal device and method of inserting a retractor. FIG. 6 is a side view of another embodiment of a retractor insertion / removal device and method of inserting a retractor. FIG. 9C is a side view of a method of removing a retractor using the apparatus shown in FIG. 9B. It is a top perspective view of an embodiment of a gel cap. It is a bottom view of an embodiment of a cap ring. FIG. 6 is a plan view of an embodiment of a gel cap that includes a plurality of access ports embedded in a gel pad. FIG. 11B is a top perspective view of the gel cap shown in FIG. 11A. FIG. 11B is a bottom perspective view of the gel cap shown in FIG. 11A. FIG. 11B is a top perspective view with the instrument inserted through two of the access ports of the gel cap shown in FIG. 11A. FIG. 11D is a bottom perspective view of the gel cap and instrument shown in FIG. 11D. FIG. 11D is a side view of the gel cap and instrument shown in FIG. 11D. FIG. 6 is a top perspective view of an embodiment of a gel cap including a fixed camera or laparoscopic port. 1 is a cutaway perspective view of an embodiment of an access device system that includes a gel cap that snap fits into a retractor. FIG. 3 is an exploded view of an embodiment of a trocar. FIG. 10 is a side view of an embodiment of a trocar including a fixed cannula in an insertion configuration. FIG. 10 is a side view of an embodiment of a trocar including a fixed cannula in a fixed configuration. FIG. 10 is a side view of another embodiment of a trocar including a fixed cannula. FIG. 10 is a side view of another embodiment of a trocar including a fixed cannula. FIG. 16B is a perspective view of an embodiment of a bolster suitable for use with the trocar shown in FIG. 16A. FIG. 10 is a side view of another embodiment of a trocar including a fixed cannula. FIG. 17B is a perspective view of an embodiment of a bolster suitable for use with the trocar shown in FIG. 17A.

  Like reference numerals refer to like components throughout.

  Embodiments of the surgical instrument access device system include single incisions such as, for example, abdominal (FIG. 1), transvaginal (FIG. 2), oral (FIG. 3), or transanal (FIG. 4) surgery. Useful for single-port and / or limited-port laparoscopic surgery.

  FIG. 5 is a perspective view of an embodiment of an access device system 5000 that includes a retractor 5100 and a cap 5500 useful in single port and / or limited port surgery. The retractor or surgical retractor 5100 is positioned and / or positioned within, and / or through, a surgical incision and / or body opening to enlarge the incision or body opening, Reform and / or isolate. Cap 5500 provides a prosthetic wall through which the instrument passes when accessing the patient's body, such as a body cavity. The components of access device 5000 include any suitable biocompatible material. US Patent Publication No. 2007 / 0088204A1 describes another embodiment of an access device system, the disclosure of which is incorporated.

  The embodiment of the retractor 6100 shown in the partial cross-sectional view of FIG. 6A extends between the inner or distal ring 6110, the outer or proximal ring 6120, and the inner ring 6110 and outer ring 6120 to couple them together. Sleeve or retracting sheath 6130. In the illustrated embodiment, the sleeve 6130 includes a substantially cylindrical flexible membrane. In other embodiments, the sleeve 6130 has another shape, such as an elliptical cross section. Embodiments of the sleeve 6130 include a flexible translucent polymer film. Some embodiments of the sleeve 6130 include one or more coatings that provide additional functionality, such as antimicrobial coatings.

  Embodiments of the inner ring 6110 are sufficiently flexible and compatible with compression and / or deformation for insertion through an incision and / or body opening. The inner ring 6110 substantially returns to its original shape or footprint when released later in the associated body cavity. In some embodiments, the inner ring 6110 assumes a substantially circular shape, for example in a relaxed state, when released in a body cavity. In other embodiments, the inner ring 6110 has another shape, such as an oval in the relaxed state. The inner ring 6110, when compressed for insertion through an incision or body opening, assumes a different shape, such as a substantially oval shape, a generally straight shape, a teardrop shape, or another suitable shape. One skilled in the art will recognize that in other embodiments, the relaxed inner ring 6110 has a shape other than circular, such as oval, elliptical, or D-shaped. In other embodiments, the inner ring 6110 is substantially rigid or non-flexible in the normal state of use.

  The embodiment of the inner ring 6110 includes a circular cross section as shown in FIG. 6A. In other embodiments, the inner ring 6110 includes another cross-sectional shape, such as at least one of an oval or elliptical shape (FIG. 6B), a teardrop shape (FIG. 6C), and a D-shape (FIG. 6D). One skilled in the art will appreciate that other cross sections are used in other embodiments. Some embodiments of the inner ring 6110 include at least one notch and / or a fragile portion that facilitates folding and deforming the inner ring 6110 to facilitate insertion and / or removal of the inner ring 6110. .

  Some embodiments of the inner ring 6110 include one or more lumens extending through the inner ring 6110. For example, the embodiment of the inner ring 6110 shown in FIG. 6A includes a lumen 6112. Embodiments of the lumen 6112 have at least one of improved elasticity and improved flexibility. In some embodiments, the placement of a wire, such as a spring metal wire, within the lumen 6112 improves the elasticity of the inner ring 6110. In some embodiments, the one or more lumens 6112 improve the compressibility of the inner ring 6110 to facilitate insertion and / or removal from the body cavity. For example, in some embodiments, the lumen (s) 6112 increase the flexibility of the inner ring 6110 to allow, for example, smaller radius folding and / or flatter compression. In some embodiments, the flexible inner ring 6110 allows the retractor to be more securely sealed against the inner wall of the body cavity. In some embodiments, an inner ring 6110 that includes one or more lumens 6112 is more than a similar inner ring 6110 that does not include a lumen, for example, by collapsing the lumen (s) 6112 in a compressed state. Are also compressed to a small size and / or cross-section.

  In some embodiments, the inner ring 6110 is manufactured as a monolithic ring or ring. In other embodiments, the inner ring 6110 is manufactured from a generally linear body that includes a first end and a second end, and these ends are integrated to provide a closed shape. The first end and the second end are then joined using any suitable means or method known in the art, for example by at least one of gluing, welding, melting, mechanical, etc. The In some embodiments, the first end and the second end of the linear body are joined using a coupler. In some embodiments, a coupler engages a lumen 6112 that is, for example, dimensioned to be received within the lumen 6112 and extending in a reverse direction from a common location of the coupler. A finger-like part and a second finger-like part are included in the first end and the second end of the main body, respectively. In an embodiment, the coupler prevents relative rotation of the first end and the second end of the coupler body.

  Returning to FIG. 6A, the outer ring 6120 includes an outer part 6122 and an inner part. In the illustrated embodiment, the outer component 6122 has a generally circular footprint and a generally oval cross section. In other embodiments, the outer component 6122 has another cross-sectional shape, such as a rectangle, hexagon, octagon, or another suitable shape. In the illustrated embodiment, the cross-section of the outer component 6122 is greater in height than in width. In some embodiments, the ratio of cross-sectional height to width is related to factors such as the overall hardness and / or stiffness of the outer part 6122 and the diameter of the outer ring 6120. More specifically, in some embodiments, the softer outer part 6122 correlates with an increase in the ratio of the cross-sectional height and width of the outer part 6122. Similarly, increasing the diameter of the outer part 6122 increases the ratio of the cross-sectional height and width of the outer part 6122. Various embodiments of the outer component 6122 include thermoplastic polyester elastomers and / or thermoplastic polyetherester elastomers (HYTREL®), DuPont, Wilmington, Del. And / or thermoplastic polyurethane elastomers (PELLETHANE®). Trademark), Dow Chemical Co., Midland, Mich.). Embodiments of the outer part 6122 are extruded, injection molded, compression molded, or overmolded. Some embodiments of the extruded outer part 6122 have ends that are heat sealed together.

  In the embodiment shown in FIG. 6A, the outer part 6122 of the outer ring extends circumferentially through the outer part 6122, a first or central lumen 6124a, a second or upper lumen 6124b, and a third or It includes three lumens 6124, the lower lumen 6124c. In some embodiments, one or both of the upper lumen 6124b and the lower lumen 6124c are optional. The central lumen 6124a is disposed about the center of the outer part 6122 at the intersection of the major and minor axes of the elliptical cross section of the outer part 6122. The upper lumen 6124b is disposed on a major axis substantially above the first side of the minor axis, ie, the central lumen 6124c. Upper lumen 6124c is disposed on the second side of the substantially minor axis, ie, the major axis below central lumen 6124c. The central lumen 6124a has an elliptical cross section and is larger than the upper lumen 6124b and the lower lumen 6124c in the illustrated embodiment. Each of the upper lumen 6124b and the lower lumen 6124c has a teardrop shaped cross-section that includes a tapered portion disposed away from the central lumen 6124a. In other embodiments, each lumen 6124 independently has another cross-sectional shape, such as a generally circular cross-section. In some embodiments, the cross-sectional shape of the lumen 6124 reduces contact between the lumen 6124 and the inner component (described below) disposed therein, thereby friction between them. And / or drag is reduced. For example, in some embodiments, the lumen 6124 has a polygonal cross section, such as a generally square, rectangular, diamond-shaped, hexagonal, star-shaped. In some embodiments, the walls of the lumen are textured to reduce contact and friction with the inner components disposed within the lumen.

  Some embodiments of the outer part 6122 of the outer ring include a split member, such as a generally straight member having a first end and a second end. The first and second ends of the members are coupled together in close proximity to each other as will be described in more detail below.

  Some embodiments of the inner part of the outer ring include a generally circular rigid wire 6126. In other embodiments, the rigid wire has another shape, such as a generally oval or elliptical shape. In the illustrated embodiment, the inner part is disposed within the central lumen 6124 b of the outer part 6122. The inner part wire 6126 is not flexible or resilient to surgical incision or natural body opening human tissue. Thus, the wire 6126 does not bend, flex and / or deform relative to the surgical incision or natural body opening human tissue during the opening of the incision or body opening. In the illustrated embodiment, rigid wire 6126 defines the peripheral shape or footprint of retractor outer ring 6120. The rigid wire 6126 functions as a rotational axis, annular axis or center point for rotating the outer part 6122 of the outer ring during wounding, as will be described in more detail below. The wire 6126 comprises a suitable material, such as hard stainless steel, which is significantly harder than the outer part 6122 of the outer ring. Some embodiments of the inner part rigid wire include a split wire 6126 having a first end and a second end. In some embodiments, the first and second ends of the rigid wire 6126 are any of at least one of welding, the use of adhesives, and / or the use of mechanical fasteners or couplers, etc. Bonded together using a suitable method.

  As described above, the inner part of the outer ring can include a generally circular rigid wire 6126. The diameter of the rigid wire 6126 is about 0.25 mm to about 12.7 mm (about 0.01 inches to about 0.5 inches). The diameter of the wire 6126 depends on the size of the wound and / or the size of the retractor 6100. For example, larger wounds correlate with increasing wire diameter. In some embodiments, the wire diameter also correlates with the wire material. For example, increasing the hardness of the wire material can decrease the wire diameter.

  Some embodiments of the rigid wire 6126 of the inner part of the outer ring start as a straight wire. The straight wire is inserted into the central lumen 6124a of the outer part. When the first and second ends of the outer part 6122 of the outer ring are joined, the wire assumes a desired shape, such as a generally circular shape or an elliptical shape, and the wire 6126 is preloaded. This load tends to cause the wire 6126 to stretch. The tendency to fully stretch the wire 6126 makes it easier for the outer ring 6120 to retain a desired shape, such as a circle or an ellipse.

  Some embodiments of the outer ring 6120 couple the first and second ends of the outer part 6122 of the outer ring together and the first and second ends of the wire 6126 of the inner part of the outer ring together. It includes a single monolithic coupler 6128 that couples. This single monolithic coupler embodiment comprises a polymer, plastic or other suitable material. In some embodiments, the monolithic coupler is a thermoplastic elastomer (HYTREL®, DuPont, PELLETHANE®, Dow), acrylonitrile-butadiene-styrene (ABS), polyamide (nylon®). , DuPont), polyether block amide (PEBAX®, Arkema) and high density polyethylene (HDPE).

  In some embodiments, the inner ring 6110 and the outer ring 6120 independently have different footprint shapes and / or footprint diameters. The larger the diameter of the inner ring 6110, the greater the retracting force, but it becomes difficult to insert into and remove from the body cavity. The larger the inner ring 6110 diameter, the easier it will roll or rotate at the time of wounding, but it will be easier to couple with a larger cap and thus may not be used in spatially constrained surgery. The oval or elongated inner ring 6110 and outer ring 6120 reduce the force required to open a long and straight incision when compared to a circular one.

  Some embodiments of the outer ring 6120 further include one or two split rings disposed within one or both of the upper lumen 6124b and the lower lumen 6124c. The split wheel will be described in more detail below.

  In some embodiments, the inner ring 6110 comprises a material that is softer than the material of the outer part 6122 of the outer ring. In other embodiments, the inner ring 6110 includes a material that is approximately as hard as the material of the outer part 6122 of the outer ring or harder than the material of the outer part 6122 of the outer ring.

  FIG. 7 is a partial cross-sectional side view of another embodiment of a retractor 7100 that is generally similar to the embodiment 6100 described above. The retractor 7100 includes an inner ring 7110, an outer ring 7120, and a sleeve 7130 that extends between the inner ring 7110 and the outer ring 7120 to couple the inner ring 7110 and the outer ring 7120 together. In the illustrated embodiment, the retractor outer ring 7120 includes an outer component 7122 having a generally elliptical cross section that includes a first lumen 7124a and a second lumen 7124b. Each of the first lumen 7124a and the second lumen 7124b has a first lumen 7124a located on a first side of an elliptical short axis and a second lumen 7124b having an elliptical short axis. And located along the major axis of the elliptical cross section. The inner part of the outer ring 7120 of the retractor is disposed in the first split ring 7126a disposed in the first lumen 7124a of the outer part of the outer ring and in the second lumen 7124b of the outer part. Second split wheel 7126b. In some embodiments, each of the first split ring 7126a and the second split ring 7126b includes a single split that forms a first end of the split ring and a second end of the split ring. Independently includes a ring having a periphery. In the neutral position, the first and second ends of each split ring are substantially adjacent to each other. In some embodiments, the split ring 7126 is substantially non-flexible, for example, in the context of using the retractor 7100 when compared to the body wall tissue under wound, the outer part 7122 of the outer ring, and the sleeve 7120. It is sex.

  In some embodiments, the characteristics of the retractor 7100, such as the retracting force applied by the retractor 7100, and the ease of retracting the opening in the body wall are determined by the first lumen of the outer part of the outer ring. Dependent at least in part on the spacing between 7124a and second lumen 7124b and the cross-sectional size or diameter of first split ring 7126a and second split ring 7126b of the inner part of the outer ring. In use, the retractor outer ring 7120 rolls below the sleeve 7130, causing the split ring 7126 to be under tension and close to the user, creating a space between the first and second ends of the ring 7124. By doing so, the split ring 7126 is opened. On the other hand, due to this rolling, the split ring 7126 is compressed and placed far from the user, and the first and second ends of the split ring 7126 are integrated. In this way, the rigid split ring 7124 distal to the user serves as the axis of rotation or center of the outer ring 7120. One or both of further increasing the distance between the two split wheels 7126 or increasing the strength of the split wheels 7126 increases the force used to roll or rotate the outer ring 7120 of the retractor. Accordingly, the distance or distance between the first lumen 7124a and the second lumen 7124b, and the cross-sectional size or diameter of the first split ring 7126a and the second split ring 7126b are determined when the body wall is opened. The outer ring 7120 is selected to balance the force to rotate the outer ring 7120 against the tendency of the outer ring 7120 to expand upon receiving a force applied to the outer ring by the body wall.

  In some embodiments, the first segment 7126a and the second segment 7126b are, for example, hard tempered wire, stainless steel, piano wire heat treated to spring temper, or substantially inflexible. Any other suitable metal that produces a ring is included. In some embodiments, the first split ring 7126a and the second split ring 7126b can be either of any form, such as by molding, machining, and / or any other suitable process known in the art. Including rigid polymeric materials made of suitable materials. The substantially inflexible split ring 7126 can also include any other suitable rigid material known in the art.

  In some embodiments, the cross-sectional diameter of the first split ring 7126a and the second split ring 7126b depends on the cross-sectional dimension of the outer part 7122 of the outer ring and the size and dimensions of the incision or body opening to be opened. Different. In some embodiments, a wire diameter of about 2.5 mm to about 3.5 mm, such as about 3 mm, is used in opening an incision about 5 cm to about 9 cm in length. In some embodiments, each of the first ring 7126a and the second ring 7126b independently comprises a wire having a diameter of about 0.25 mm to about 6.35 mm (about 0.01 inch to about 0.25 inch). Included.

  The first split ring 7126a and the second split ring 7126b of the inner part of the outer ring have a smaller diameter in the relaxed state than the first lumen 7124a and the second lumen 7124b, respectively, in which they are respectively disposed. . Thus, when the outer ring 7120 is in a relaxed state, each of the split wheels 7126 is under tension and the outer part 7122 is compressed. As a result, in some embodiments, split ring 7126 retains outer part 7122 of the outer ring in a closed configuration. In some embodiments, the compression force of the first split ring 7126a and the second split ring 7126b also controls the orientation of the outer part 7122 in the relaxed state, i.e. the split ring 7126 is in a substantially up-down relationship. The major axis of the cross section of the outer part 7122 is substantially parallel to the longitudinal axis of the outer part 7122.

  In some embodiments, the individual split wheels 7126 are manufactured as a circle or other desired shape, and the first and second ends overlap one another. In some embodiments, the dimensions of the first and second lumens 7124b and the outside of the outer ring when the first split ring 7126a and the second split ring 7126b are disposed within the lumen, respectively. The configuration of the part 7122 prevents the first and second ends of the individual split wheels from overlapping. In some embodiments, the lumens 7124 are dimensioned so that they are substantially adjacent to each other when the first and second ends of the individual split rings 7126 are disposed within the lumens 7124. Other embodiments include a slight gap between the first and second ends of at least one split ring 7126 disposed within lumen 7124. The compression spring force from the expanded split ring urges the outer part 7122 to remain closed. Since the split ring 7126 is disposed on both sides of the short axis of the cross section of the outer part 7122, the first split ring 7126a and the second split ring 7126b have the long axis of the cross section of the outer part 7122 of 0 ° and 180 °. The outer ring 7120 is urged to remain vertical with this orientation, and its configuration is maintained, thereby facilitating mounting of the cap on the outer ring 7120 of the retractor, as will be described below. In some embodiments, for example, at least of the relative position of the lumen 7124, the relative diameter of the lumen 7124, the relative relaxation diameter of the split ring 7126, the relative cross-sectional diameter of the split ring 7126, and the relative composition of the split ring 7126 By changing one, the outer ring 7120 is designed with an orientation bias other than vertical.

  When the outer ring 7120 is in a relaxed configuration, each of the first split ring 7126a and the second split ring 7126b has first and second ends that are substantially adjacent so that each of the split rings 7126 In the retraction process, the outer part 7122 functions continuously as a central axle when rotating half or 180 °. More specifically, as the outer ring 7120 rolls, the first split wheel 7126a, initially above the second split wheel 7126b, surrounds the second split wheel 7126b that serves as the axle or rotation axis and Rolling or rotating outward, the periphery of the first split ring 7126a expands and passes through the periphery of the second split ring 7126b, so that the first split ring 7126 becomes the second split ring. Come down below. When the outer ring 7120 continues to roll, the roles of the first split ring 7126a and the second split ring 7126b are reversed, and the second split ring 7126b rolls around and outside the first split ring 7126a. The peripheral portion of the second split wheel 7126b expands and passes through the periphery of the first split wheel 7126b that functions as a rotating axle. These steps are repeated until the incision or body opening is opened to the desired extent.

  In some embodiments, the retractor outer ring 7120 includes an extruded elastic tube of a desired shape, such as a generally circular or elliptical ring. In some embodiments, the first split ring 7126a and the second split ring 7126b disposed in the first lumen 7124a and the second lumen 7124b of the outer part 7122 are respectively the skeleton of the outer ring 7120. Alternatively, it acts as a scaffold, which determines the overall shape of the outer ring 7120. In some embodiments, one of the first and second ends of the first split ring 7126a is inserted into the first lumen 7124a of the outer part and the first and second of the second split ring 7126b. One of the two ends is inserted into the second lumen 7124b of the outer part. Each of the first split ring 7126a and the second split ring 7126b is continuously fed into the respective lumen 7124 until each of the split rings 7126 is substantially completely within the respective lumen 7124. . In general, the outer part 7122 has a shape in which the split ring 7126 is positioned in the first lumen 7124a and the second lumen 7124b. Some embodiments further include a coupler disposed between the first and second ends of the outer component 7122.

  Referring again to the outer part 7122 of the outer ring, when the outer part 7122 rotates around the inner part, a lock point is formed by the ratio of the cross-sectional height and cross-sectional width of the outer part 7122. As the outer ring 7120 is rotated, the sleeve 7230 rolls up around the outer ring 7120 so that the locking point reduces or prevents reverse rotation of the outer ring 7120, thus unwinding the sleeve 7230 from the outer ring 7120. Or spread is prevented. These lock points also provide an incremental rotational position for the outer ring 7120, which provides for the incremental retraction of the wound. The generally symmetric cross-sectional shape provides a substantially uniform rotational movement and locking point, which provides a substantially uniform “click” sensation for each incremental rotation. The lock point also serves to prevent the first outer part of the second outer ring from tilting as a result of the forces encountered when opening a surgical incision or body opening. The illustrated embodiment includes a lock point where the major cross-section of the outer part 7120 is substantially perpendicular or parallel to the longitudinal axis of the outer part 7120, ie, 0 ° and 180 °.

  As described above, embodiments of outer component 7120 include a thermoplastic elastomer material such as HYTREL® (DuPont) or PELLETHANE® (Dow). Increasing the hardness of the material of the outer part 7122 increases the force used to rotate the outer ring 7120 and the resistance to unlock the outer ring 7120 from the individual lock points with each rotation of the outer ring 7120. . Accordingly, the hardness of the material of the outer part 7122 and the cross-sectional height and width of the outer part 7122 are selected to provide a suitable or sufficient locking point for the outer ring 7120. For example, increasing the ratio of the height and width of the cross-section of the outer part 7122 can provide similar locking point resistance, ie, a “clicking sensation”, while reducing material hardness. Conversely, when the material hardness is increased, the ratio of the height and width of the cross section of the outer part 7122 can be reduced.

  Various embodiments of the outer ring 7120 footprint are symmetrical or asymmetrical, such as circular, oval, elliptical, or any other suitable shape to suit body shape, posture or size. Can vary in size and shape, thereby increasing or improving the working space or reducing the possibility of interfering with other instruments or ports during laparoscopic surgery.

  Reducing the cross-sectional profile or size of the retractor outer ring 7120 increases the range of angles for inserting instruments inserted through the outer ring 7120. More specifically, one or both of the cross-sectional height and width of the outer ring 7120 can be reduced. Increasing the angle range of insertion is particularly useful for the opening of body openings such as rectal or vaginal retractions. Reducing the cross-sectional profile of the outer ring 7120 makes it more difficult to roll or rotate the outer part 7122 of the outer ring around the inner part of the outer ring 7120 during retraction. Thus, in some embodiments, a suitable tool is used to facilitate rolling the outer part 7122 around the inner part.

  While referring to the embodiment of the retractor 6100 shown in FIG. 6A, an embodiment of a surgical operation to open an incision or body opening will be described, this operation will be applied to all of the retractor embodiments disclosed herein. Applicable. In use, the surgical retractor 6100 may have an incision such as an incision formed in the abdominal wall (FIG. 1) or a body opening such as the vagina (FIG. 2), mouth (FIG. 3) or anus (FIG. 4). Inserted into. Inner ring 6110 may be folded or compressed into an oval or other suitable shape, or urged through an incision or body opening into the associated body cavity. The inner ring 6110 can regain its original relaxed shape, such as a generally circular, oval or other original shape, when placed completely within the associated body cavity. Thereafter, by pulling up the outer ring 6120, the inner ring 6110 is pulled up so as to contact the inner surface of the body cavity.

  When the inner ring 6110 is completely in place, the outer ring 6120 is rolled or rotated around an annular axis defined by its inner part. As described above, in the rolling procedure, the part of the outer part 6122 that is far from the user passes through the inside of the annular shaft when moving toward the user, while the part of the outer part 6122 that is closer to the user is away from the user. Passes around the annular shaft when leaving. As the outer ring 6120 rolls, the sleeve 6130 rolls around the outer ring 6120, reducing the distance between the inner ring 6110 and the outer ring 6120 and tensioning the sleeve 6130 therebetween, thereby An incision or body opening is opened.

  The outer ring 6120 is rolled until the desired state or degree of retraction is achieved by the outer ring 6120 and a portion of the sleeve is wrapped around the outer ring 6120 and substantially contacts the outer surface of the body wall. When the outer ring 6120, and the portion of the sleeve wrapped around it, contacts the outer surface of the body wall, the outer ring 6120 of the retractor is desired in the incision or body opening, eg, substantially fully retracted. Sufficiently stiff to hold a state or degree of retraction. In some embodiments, the incision or human body opening is not fully retracted, but instead only partially retracted, thereby causing the cover 5500 (FIG. 5) associated with the retractor 6100 to be in the incision or opening. You can move to some extent. Further, when the outer ring 6120 wrapped around a portion of the sleeve contacts the outer surface of the body wall, the outer ring 6120 of the retractor becomes inflexible, i.e., deflects under the forces normally experienced when using the retractor 6100. Less flexibility or possibility. Thus, embodiments of the rigid outer ring 6120 facilitate opening the incision or human body opening 360 ° intact. The retractor 6100 shown is a durable device that reliably protects the incision or body opening during surgery.

  As shown in FIG. 5, some embodiments of the access device 5000 include a cap, cover, or lid 5500 that is coupled to the outer ring of the retractor 5100 and seals the retractor 5100, eg, to maintain a pneumoperitoneum. Including. In some embodiments, the lid 5500 is removable to allow access, for example, into a body cavity. Some embodiments of the lid 5500 include a transparent or translucent portion that allows the user to view the body cavity without removing the lid 5500. As described below, one embodiment of the lid 5500 is a gel cap. In some embodiments, the cross-sectional shape of the outer part 6112 (FIG. 6A) of the retractor outer ring is such that the lid 5500 partially and / or incorrectly couples to the outer ring 6110 (FIG. 6A) of the retractor. Is selected to reduce or prevent. Such cross-sectional shapes include any other suitable cross-sectional shape that provides the desired functionality, such as elliptical and rectangular, or hexagonal, octagonal, and the like. Also, depending on the application and surgeon preference, in some embodiments, each of the retractor inner ring 6110 and outer ring 6120 includes an independently variable design configuration. For example, embodiments of the inner ring 6110 and / or the outer ring 6120 are rigid or flexible and have a circular or elliptical footprint, a diameter that depends on the incision or opening dimensions, or a cross-sectional dimension that depends on the retracting force. The installation area, the cross-sectional shape, and / or the dimension according to the intended use.

  Accordingly, embodiments of the retractor 6100 allow a surgeon to easily open a surgical incision or natural body opening and easily accommodate variations in body wall thickness between patients while protectively lining. Also, the embodiment of the device 6100 effectively seals the interior and exterior of the incision or opening, allowing a seal cap 5500 (FIG. 5) to be coupled to the device 6100, thereby effectively removing the body cavity. Seal and allow surgery.

  FIG. 8A is a partial cross-sectional side view of another embodiment of a retractor 8100 that includes an inner ring 8110, an outer ring 8120, and a flexible sleeve 8130. A tether 8140 includes a distal end 8142 secured to the inner ring 8110. The tether proximal end 8144 extends through the sleeve 8130 and the outer ring 8120 and terminates with an optional handle 8146 in the illustrated embodiment. As shown in FIG. 8B, in an embodiment of a method for removing retractor 8100 from a patient, pulling tether handle 8146 causes inner ring 8110 to be drawn toward outer ring 8120. Further pulling on the tether 8140 causes the inner ring 8110 to contact the outer ring 8120, thereby deforming as the inner ring 8110 passes through the outer ring 8120. US Patent Publication No. 2006 / 0149137A1 discloses various embodiments of tethers, the disclosure of which is incorporated herein by reference.

  In some embodiments, the tether includes fibers, woven cords or braids. In some embodiments, tether 8140 includes a tube. In some embodiments, the tether 8140 includes a cord and tube disposed within the tube, integrated into the wall of the tube, or secured to the outer wall of the tube, for example. The tether 8140 can be any suture material, polymer resin, polyamide (nylon (registered trademark), Dacron (registered trademark)), polyester, silk, polyethylene, polyether block amide (PEBAX (registered trademark)), etc. Any suitable material.

  In some embodiments, the tether 8140 is releasably secured to the inner wall of the sleeve 8130 and wraps around the outer ring 8120 as the outer ring 8120 rotates about the annular axis during retraction. Is released from the end of the sleeve 8130 close to the outer ring 8120.

  In some embodiments where the tether 8140 includes a tube, the tether further includes at least one fluid opening through the wall of the tube disposed at or near the distal end 8142. In some of these embodiments, the tether 8140 is also useful as a gas inlet / outlet for, for example, an insufflation gas. In some operations, the body wall forms a constriction in the sleeve 8130 when using the retractor 8100. This constriction can limit the exchange and / or movement of gas between the volume below the constriction and the volume above the constriction. In particular, the fluid opening at the tether distal end 8142 is below the constriction, and the fluid opening located at or near the outer ring 8120 or cap or cover 5500 (FIG. 5) is above the constriction. Exists. Placing the fluid opening below the constriction of the tether 8140 facilitates gas injection into and / or out of the volume below the constriction, for example in electrosurgical procedures such as cutting and cauterization. It is particularly useful for exhausting the generated vapor and / or smoke from the body cavity. In some embodiments, a fluid opening at the proximal end 8142 of the tubular tether extends through the gel cap and is fluidly connected to a gas source and / or a vacuum source. In other embodiments, the fluid opening at the proximal end 8142 of the tether is fluidly coupled to another gas fitting, eg, disposed within the gel cap.

  FIG. 9A is a side view of an embodiment of an insertion tool 9700 for inserting the inner ring 9110 of the retractor 9100. FIG. The insertion tool includes an obturator 9710 and a cannula 9720. Obturator 9710 includes an elongated cylinder 9712 that includes a proximal end and a distal end, a handle 9714 at the proximal end of cylinder 9712, and a hook 9716 at the distal end of the cylinder. Cannula 9720 includes a tubular body 9722 including a proximal end and a distal end, and a handle 9724 at the proximal end. Tubular body 9722 opens at both the proximal and distal ends and is sized to slidably receive obturator cylinder 9712 therein. Tubular body 9722 is also sized to receive at least a portion of retractor inner ring 9110. US Patent Publication No. 2006 / 0149137A1 describes other embodiments of insertion and extraction tools, the disclosure of which is incorporated herein by reference.

  As shown in FIG. 9A, the inner ring 9110 is pushed into the distal end of the cannula tubular body 9722, after which the cannula is inserted through an opening or incision 9752 in the body wall 9750. The distal end of obturator 9710 is inserted and advanced through the proximal end of tubular body 9722, thereby urging inner ring 9110 out of tubular body 9722 and into body cavity 9754.

  FIG. 9B illustrates another embodiment of a method for inserting the inner ring 9110 into the body cavity 9754 through the opening 9752 without using the cannula 9720. In this embodiment, a portion of the inner ring 9110 is captured by a hook 9716 located at the distal end of the obturator. The distal end of obturator 9710 and captured inner ring 9110 are urged to enter body cavity 9754 through opening 9752.

  FIG. 9C illustrates an embodiment of a method of removing inner ring 9110 using obturator hook 9716. The distal end of obturator 9710 is inserted between sleeve 9130 and body wall 9750 through opening 9752 in the body wall. After the inner ring 9110 is captured by the hook 9716, the obturator 9710 and the inner ring 9110 are pulled out from the opening 9752.

  FIG. 10A is a perspective view of an embodiment of a cap or cover 10500 that is a surgical access device that provides access from outside the body cavity into the body cavity while sealing the opening between the body cavity and the region outside the body cavity. Yes. More particularly, the illustrated cap 10500 releasably couples to the retractor outer ring 6120 (FIG. 6A) while sealing it. Cap 10500 includes a cap ring 10510 sized and configured to couple to retractor outer ring 6120 and pad 10530 coupled to cap ring 10510. Various embodiments of the cap 10500 provide the artificial body wall with consistent properties compared to the natural body wall, such as thickness, flexibility, stiffness, and uniformity.

  The illustrated cap or cover 10500 is substantially circular. In other embodiments, the gel cap 10500 has another shape or footprint, such as an oval, oval, parabolic, square, rectangular, or another suitable curved or polygonal shape. In some embodiments, the retractor outer ring 6120 and the cap cap ring 10510 have the same general shape or footprint. In other embodiments, the retractor outer ring 6120 and cap cap ring 10501 have substantially different shapes, for example, a generally circular outer ring 6120 and an elliptical cap ring 10510. In these embodiments, the outer ring 6120 is deformed or reshaped to mate with the cap ring 10510, for example, by compressing both sides of the outer ring 6120. For example, non-circular shapes are useful for surgery where space is limited. As noted above, using an oval or elongated retractor to open a long straight incision requires less force than a similar operation using a circular retractor.

  In some embodiments, pad 10530 includes a gel. In such an embodiment, pad 10530 is referred to as a “gel pad” and cap 10500 is referred to as a “gel cap”. In general, the description of the gel pad and gel cap applies to embodiments where the pad 10530 does not include a gel unless otherwise specified. In some embodiments, the gel pad 10530 does not include a pre-formed access channel through which the instrument passes for access, for example. An access channel or access can be formed in the gel pad 10530 by piercing the gel pad 10530 and the instrument can be inserted directly through the gel pad 10530. The individual access sections form an instrument seal when there is an instrument inserted through the access section and a zero seal when there is no instrument inserted through the access section. The gel provides a hermetic seal around instruments of various shapes and sizes that are inserted through the access. Some embodiments of the gel pad 10530 also provide trocar access directly through the gel pad 10530, which also provides instrument access into the body cavity. Embodiments of the gel pad 10530 have a working diameter of about 40 mm to about 120 mm, which is the diameter of the portion of the gel pad 10530 into which instruments and / or trocars can be inserted. Typically, the embodiment of the gel cap 10500 is approximately 10 mm to 50 mm wider than the working diameter.

  Thus, the embodiment of the gel cap 10500 retains the pneumoperitonee during the exchange of multiple devices and substantially prevents unintentional pneumoperitoneal loss. The embodiment of the gel cap 10500 also provides substantially sustained access and visibility during surgery. Embodiments of the gel cap 10500 have a small profile for use in surgery with limited surgical space.

  In some embodiments, the gel is an ultragel characterized by an elongation of greater than about 1000 percent and a durometer of less than about 5 Shore A. Some embodiments of ultragels, including KRATON® and mineral oil, exhibit improved sealing properties that extend over about 1500 percent and seal instruments in a wider size range than other sealants . In some embodiments, the seal comprising the ultragel also forms a zero seal when the instrument is removed from the seal. Thus, in some embodiments of seals comprising ultragel, one seal serves as an instrument seal and zero seal.

  Some embodiments of the cap ring 10510 include a generally cylindrical ring that includes a proximal portion, a distal portion, and a longitudinal axis extending from the proximal portion to the distal portion. In other embodiments, the cap ring 10510 has another shape or footprint, such as an ellipse. As best seen in FIG. 10B, which is a bottom view of the cap ring 10510, in the illustrated embodiment, the proximal portion of the cap ring 10510 includes a plurality of apertures 10512 distributed around its periphery. Aperture 10512 extends to wall 10514 at the proximal portion of the cap ring. In another embodiment, the aperture 10512 is disposed on at least one member extending longitudinally inward or longitudinally outward from the cap ring wall 10514. In the illustrated embodiment, a gel pad 10530 is disposed proximal to the cap ring 10510 and some portions of the gel pad 10530 extend through the aperture 10512 so that the cap ring 10510 and the gel pad 10530 are between the cap ring 10510 and the gel pad 10530. A connection structure is formed that mechanically locks the gel pads 10530 together.

  In the illustrated embodiment, the distal portion of the cap ring 10510 is generally cylindrical and is sized and configured to receive the retractor outer ring 6120 (FIG. 6A). Cap ring 10510 includes a latch mechanism 10516 that removably couples cap ring 10510 to outer ring 6120. Those skilled in the art will recognize the protruding ring, lever, clip, latch, tongue, groove, thread, bayonet mount, screw, friction fastener, compression to couple the cap ring 10510 to the outer ring 6120 of the retractor. It will be appreciated that other mechanisms such as fasteners, snap caps, etc. are also useful. In the illustrated embodiment, when the retractor outer ring 6120 is received within the distal portion of the cap ring 10510, the retractor outer ring 6120 is placed on a portion of the gel pad 10530 disposed at the distal portion of the cap ring 10510. In contact and into this, a portion of the gel is displaced and a seal is formed between the gel pad 10530 and the outer ring 6120 and sleeve 6130 of the retractor. Thus, the distal portion of gel pad 10530 is juxtaposed with the incision or body opening. In other embodiments, the cap ring 10510 is permanently coupled or secured to the outer ring 6120.

  In some embodiments, the cap ring 10510 comprises a polymer. Examples of suitable polymers include polyethylene (PE), low density polyethylene (LDPE), high density polyethylene (HDPE), ultra high molecular weight polyethylene (UHMWPE), polycarbonate, thermoplastic elastomer (DYNAFLEX®, GLS, KRATON). (Registered trademark), Kraton Polymers), polyphenylene oxide (PPO), polystyrene, and the like. The polymer part of the cap ring is manufactured by any suitable method such as injection molding, melt casting, blow molding and the like.

  Some embodiments of the process by which the gel pad 10530 is cast into the cap ring 10510 include a step performed at a temperature above about 130 ° C. for several hours, such as about 3 to about 4 hours. Thus, in some of these embodiments, the cap ring 10510 does not deform under these conditions.

  Some embodiments of the gel pad 10530 include an elastic gel. Examples of such gels are described in US patent application Ser. No. 10 / 381,220, filed Mar. 20, 2003, the disclosure of which is fully incorporated herein by reference. As if incorporated herein. Gel embodiments are prepared by mixing at least one triblock copolymer with a solvent that dissolves the middle block of the triblock copolymer. Usually this mixture is a slurry. Typically, the end block comprises a thermoplastic material such as styrene, while the middle block comprises a thermosetting elastomer such as ethylene / butylene, isoprene or butadiene. Examples of triblock copolymers include styrene-ethylene / butylene styrene (SEBS), styrene-isoprene-styrene (SIS), and styrene-butadiene-styrene (SBS). In some embodiments, the solvent is an oil such as mineral oil. When the triblock copolymer mixture or slurry is heated, the middle block dissolves in the mineral oil, thereby forming a network of insoluble end blocks. The resulting network has enhanced elastic properties compared to the original copolymer. In some embodiments, the triblock copolymer used is KRATON® G1651 with a styrene to rubber ratio of 33/67. Once formed, this gel is substantially permanent and can then be treated as a thermoplastic elastomer due to the nature of the end blocks. The mixture or slurry has a minimum temperature to become a gel, which is called the minimum gel temperature (MGT). Usually this temperature corresponds to the glass transition temperature of the thermoplastic end block +2, 3 degrees. For example, the MGT of a mixture of KRATON® G1651 and mineral oil is about 120 ° C. When the slurry reaches the MGT and changes to the gel state, the gel becomes more transparent, which provides a visual endpoint that confirms that the slurry has completely changed to the gel state, at which point the gel is cooled. can do. Some embodiments of the gel comprise a diblock copolymer instead of or in addition to the triblock copolymer. Various embodiments of the diblock copolymer include a thermoplastic first end block such as styrene and a second end block of a thermoset elastomer such as ethylene / butylene, isoprene or butadiene. An example of a suitable diblock copolymer is styrene-ethylene / butylene (SEB).

  For a given mass of slurry to form a complete gel, the total mass of the slurry should be above MGT so that the end blocks have sufficient time to form an interconnected network or matrix. Heat to keep above this temperature. The slurry continues to form a gel at a temperature between the MGT and the temperature at which the slurry / gel components begin to decompose and / or oxidize. For example, if the slurry / gel is heated above 250 ° C., the mineral oil in the slurry / gel becomes unstable and begins to oxidize. Oxidation can make the gel brown and oily.

  The rate at which a given volume of slurry forms a gel depends on the rate at which the entire mass of slurry reaches the MGT. Also, at temperatures higher than the MGT, the end block network is more rapidly dispersed and formed, thereby promoting gel formation.

  Various base gel formulations can be mixed or alloyed with each other to provide gels with various intermediate properties. For example, KRATON® G1701X is a mixture of 70 percent (70%) SEB and 30 percent (30%) SEBS with an overall ratio of styrene to rubber of 28/72. One of ordinary skill in the art will see an almost unlimited number of combinations, alloys, and styrene to rubber ratios that each provide embodiments that exhibit one or more advantages such as low durometer, high elongation, and good tear strength. You will recognize that you can devise.

  Some embodiments of the gel material further include a polymer that improves the sealing properties of the gel with a foaming agent, such as silicon, soft urethane, and even harder plastics. Examples of suitable silicon include those used for electronic encapsulation. Examples of suitable harder plastics include polyvinyl chloride (PVC), isoprene, KRATON® neat, and other KRATON® / oil mixtures. In the KRATON® / oil mixture, suitable oils include vegetable oils, petroleum and silicone oils, and mineral oils.

  Some embodiments of the gel include one or more additives that provide one or more desirable properties, such as at least one of enhanced lubricity, improved appearance and wound protection. . The additive is incorporated directly into the gel and / or applied as a surface treatment. In some embodiments, other compounds are added to the gel to modify physical properties and / or provide binding sites and / or surface charges to assist in subsequent surface modification. Also, in some embodiments, oily colorants are added to the slurry to form different colored gels.

  Some embodiments of the gel pad 10530 include a polyethylene layer on at least one surface. The polyethylene dissolves in mineral oil and a solution applied to one or more sides of the gel pad 10530. Mineral oil does not evaporate, but instead is absorbed by the gel pad over time, leaving behind polyethylene as a layer on the surface of the gel pad.

  In some embodiments, the triblock copolymer / solvent mixture / slurry used to make the gel pad 10530 is about 90 weight percent (90%) mineral oil and about 10 weight percent (10%) KRATON. (Registered trademark) G1651. From a thermodynamic point of view, this mixture behaves like a mineral oil. Because mineral oil has a relatively high heat capacity, it can take from about 3 to about 4 hours to transform a 0.45 kg (1 lb) slurry into a homogeneous gel at about 130 ° C. Once formed, the gel can be allowed to cool as quickly as possible without apparently adversely affecting the gel. In some embodiments, the gel is cooled by cold water immersion. In other embodiments, the gel is air cooled. One skilled in the art will recognize that other cooling techniques may be used in other embodiments.

  Some properties of the KRATON® / oil gel depend on the weight ratio of the components. Generally, when the proportion of mineral oil is high, the gel becomes soft, and when the proportion of KRATON (registered trademark) is high, the gel becomes hard. If the gel is too soft, the gel cap 10500 will be excessively tented or domed when air is delivered to the patient's body cavity during surgery. Some embodiments of gels that are too soft also provide a proper instrument seal and / or zero seal. However, the gel should be soft enough to provide a suitable seal both in the presence of the instrument and in the absence of the instrument.

  If it is left for a long time, a copolymer such as KRATON (registered trademark) in the slurry and a solvent such as mineral oil may be separated. The slurry can be mixed with a high shear mixer to increase uniformity. However, mixing the slurry can introduce or add air to the slurry. The slurry can be degassed to remove air from the slurry. In some embodiments, the slurry is degassed under vacuum, for example, in a vacuum chamber. In some embodiments, the applied vacuum is about 0.79 mercury columns (about 29.9 inches of mercury), or about 1 atmosphere. Optionally, air is easily removed by stirring or mixing the slurry under vacuum. During degassing under vacuum, the slurry typically expands and then foams and then decreases in volume. Usually, the vacuum is stopped when bubbling substantially stops. As the slurry is degassed in the vacuum chamber, the volume of the slurry is reduced by approximately 10 percent (10%). In some embodiments, degassing the slurry reduces oxidation of the finished gel.

  When the slurry is degassed, the gel tends to harden. A gel formed from a degassed slurry containing about 91.6 wt.% Mineral oil and about 8.4 wt.% KRATON® G1651 in a ratio of 11: 1 is about 90 weight percent (90%) mineral oil. And about the same hardness as a gel formed from a non-degassed slurry containing about 10 weight percent (10%) KRATON® G1651 in a 9: 1 ratio.

  Since mineral oil is usually less dense than KRATON®, the two components separate after mixing, and the mineral oil that is less dense rises above the vessel. Usually, this phase separation occurs when a static slurry is turned into a gel over several hours. For this reason, the resulting gel is non-homogeneous, with higher concentrations of mineral oil at the top and lower concentrations at the bottom. The separation rate is a function of the depth or top height of the slurry being heated. Factors related to the relative homogeneity of the gel include the mass of the slurry, the top height, the temperature at which the gel solidifies, and the rate at which energy is transferred to the gel.

  In some embodiments, the gel pad 10530 or gel cap 10500 is gamma sterilized, which is relatively and / or relatively easy to tolerate compared to other sterilization processes such as ethylene oxide. . However, gamma sterilization can form large bubbles in the gel pad, which is a cosmetic and / or aesthetic problem in sterilized devices. Typically, the foam contains more than 99 percent (99%) of room air so that dissolved air is advantageously removed from the slurry before turning the slurry into a gel. For example, as described above, the slurry can be degassed under vacuum and then gelled by heating. During gamma sterilization, some foam may form in the gel but usually disappears over about 24 to about 70 hours. Typically, room temperature mineral oil has about 10 percent (10%) dissolved gas. As mentioned above, the gel solidifies when air is removed from the gel. However, this effect is offset by the softening of the gel by gamma radiation during gamma sterilization.

  In some embodiments where gel pad 10530 is gamma sterilized, the gel comprises about 90 weight percent (90%) mineral oil and about 10 weight percent (10%) KRATON®. As described above, when the slurry is degassed, the gel is solidified. However, it is gamma sterilized without degassing, including about 90 weight percent (90%) mineral oil and about 10 weight percent (10%) KRATON®, offset by softening by gamma radiation. A gel having the same hardness as that of the obtained gel can be obtained.

  In some embodiments, a gel pad 10530 is coupled to, attached to, formed together with, or integrated with the cap ring 10510 to provide a hermetic seal between the cap ring 10510 and the sleeve 6130 (F1G.6A). . Gel pad 10530 covers and seals the entire opening of cap ring 10510 and substantially covers the entire wound or human body opening. As described above, the gel pad 10530 provides a hermetic seal around instruments of various shapes and sizes inserted therethrough.

  In embodiments where the gel pad support structure of the cap ring 10510 includes a thermoplastic elastomer such as DYNAFLEX® or KRATON®, and the gel pad 10530 includes a similar thermoplastic elastomer such as KRATON®, the gel pad 10530. And improved adhesion between the cap ring 10510. The KRATON® polystyrene component within the gel pad 10530 improves adhesion with polyphenylene oxide (PPO), polystyrene and other similar polymers.

  In some embodiments where the cap ring 10510 includes polycarbonate, the polycarbonate component of the cap ring 10510 does not bond to the gel pad 10530 at 130 ° C., which is a typical manufacturing temperature for a gel pad 10530 that includes KRATON®. However, if the temperature is raised to about 150 ° C. over several minutes during casting, the gel pad 10530 will bond to the cap ring 10510. It is believed that heating the gel pad 10530 and the cap ring 10510 to a temperature where both the polystyrene component of the gel and the polycarbonate simultaneously exceed the melting point will allow a bond to form between them. In other embodiments, the gel pad 10530 bonds to the cap ring 10510 by heating the uncured gel and cap ring 10510 near or to the glass transition temperature of the polycarbonate in the cap ring 10510.

  In some embodiments, the gel comprises mineral oil and the cap ring 10510 is manufactured under conditions such as polyethylene (PE), low density polyethylene (LDPE), high density polyethylene (HDPE) and ultra high molecular weight polyethylene (UHMWPE). And a polymer that dissolves in mineral oil. Using polyethylene (PE) as an example, PE has a higher molecular weight than mineral oil and dissolves in mineral oil at the temperature used to cast gel pad 10530. Accordingly, a portion of the PE in the cap ring 10510 dissolves in the mineral oil in the gel pad 10530 at a processing temperature, for example, greater than about 130 ° C., resulting in a bond between the PE in the cap ring 10510 and the gel pad 10530.

  In an embodiment of a method for manufacturing a gel cap, the cap ring 10510 is placed in a mold that is integrated with the cap ring 10510 to include a negative space in the desired shape of the gel pad, and the mold is uncured. Add the gel. Thereafter, sufficient uncured gel is added to the mold to cover and fill the aperture 10512. The uncured gel flows through the aperture, fills it and remains in the aperture. Also, in some embodiments, the mold is filled with enough uncured gel to extend into the distal portion of the cap ring 10510. After the gel hardens, the gel in the apertures connects the gel on the first face of each aperture 10512 to the gel on the second face of the aperture to bond the gel pad 10530 to the cap ring 10510. Locked mechanically.

  In addition to or in lieu of the mechanical linkage described above, some embodiments include another method of coupling the gel pad 10530 to the cap ring 10510. Such a method is useful, for example, for joining separately formed gel pads or gel slugs 10530 and cap rings 10510. Some embodiments use an adhesive or adhesive such as cyanoacrylate (SUPERGLUE® or KRAZY GLUE®) to bond the gel pad 10530 to the cap ring 10510. This sticker binds to either the rubber or the styrene component of the triblock copolymer, and this bond is often considered stronger than the bond to the gel material itself. Some embodiments use solvent bonding where the solvent dissolves the plastic in the cap ring 10510 and the polystyrene in the gel pad 10530. The solvent is applied to the gel pad 10530 and the cap ring 10510 by any suitable method such as spraying and / or dipping. In practice, the solvent dissolves the plastic in the cap ring 10510 and the polystyrene in the gel pad 10530, resulting in a bond between them, which remains after the solvent evaporates.

  In an embodiment of manufacturing the gel cap 10500, the gel pad 10530 is cast into the cap ring 10510 to form the gel cap 10500. Cap ring 10510 is positioned or placed within the mold cavity of the mold. The mold cavity embodiment includes a support for the annular wall of the cap ring 10510. Mold embodiments include materials having sufficient heat dissipation characteristics, such as at least one of aluminum, copper, and brass. One skilled in the art will recognize that in some embodiments, acceptable parts are produced with other mold materials that have poor heat dissipation characteristics. In addition, some embodiments of the mold include active cooling elements such as grooves that feed coolant.

  The mold cavity and cap ring 10510 assembly is then filled with the desired amount of triblock copolymer / mineral oil slurry so that the slurry contacts the cap ring 10510. In some embodiments, the slurry is preheated to, for example, about 52 ° C. (125 ° F.), thereby facilitating full filling of the mold cavity with the slurry, thereby reducing the probability of voids in the gel. Preheating the slurry to a temperature below the MGT reduces the viscosity of the slurry and allows the slurry to flow more easily. As mentioned above, some embodiments of the slurry are evacuated in vacuum prior to casting. In some embodiments, the slurry is filled into the mold cavity to remove air that may have been introduced during the mold cavity filling and to facilitate the flow of the slurry into the mold cavity. After degassing. The mold, cap ring and slurry are heated, eg, in a furnace, until the slurry reaches a temperature of about 150 ° C. As described above, the slurry turns into a gel at about 120 ° C., which bonds to the polycarbonate cap ring 10510 at about 150 ° C. Depending on the material used for the cap ring 10510, bonding may occur at temperatures other than about 150 ° C. In embodiments where the cap ring 10510 includes a material having a melting point lower than the MGT, such as 120 ° C., the gel pad 10530 is separately molded as a gel slug, which is then bonded to the cap ring 10510 as described above.

  For example, if the slurry is completely converted to gel, when the gel pad temperature reaches about 150 ° C., the gel cap 10500 is cooled, for example, by air cooling, cold water immersion, or another suitable method. At 150 ° C., the gel pad 10530 is soft and easily distorted. The distortion of the gel pad 10530 that appears during cooling is set after cooling. Thus, in some embodiments, cooling the gel cap 10500 in the mold reduces the likelihood of the gel pad 10530 being distorted. Factors that affect the cooling time include the size and configuration of the mold, the amount of gel, the temperature and amount of the cooling medium, the characteristics of the cooling medium, and the mold material. As an example, the cooling time for a particular gel cap 10500 can be about 2 hours for air cooling and about 15 minutes for water cooling. Regardless of air or water cooling, the final properties of the gel are substantially the same. Typically, the gel cap 10500 is cooled to approximately ambient room temperature, but can be cooled to a lower temperature if desired. The gel cures at about 0 ° C., which is useful in secondary operations, for example, when combining separately manufactured gel pads 10530 and cap rings 10510. The gel cap 10500 can be removed from the mold at any time after the gel is cured.

  When removed from the mold, the gel pad 10530 typically has a sticky surface. Coating gel pad 10530 with a powder such as corn starch substantially reduces or eliminates the tackiness of cured gel pad 10530.

  As described above, in some embodiments, the gel pad 10530 is molded separately from the cap ring 10510 and bonded to the cap ring 10510 in a secondary operation such as bonding. In some embodiments, the gel pad 10530 is shaped as a gel slug whose outer periphery is smaller than the circumference of the inner cylindrical wall of the cap ring 10510 and whose height is higher than the height of the cap ring 10510. Since the gel pad 10530 is molded separately from the cap ring 10510, the slurry can be heated to an MGT, such as about 120 ° C., where the gel becomes substantially transparent in order to turn the gel completely into slurry. As described above, the gel slag can be cooled to about 0 ° C. or the like and then placed within the inner cylindrical wall of the cap ring 10510.

  In some embodiments, compressing the gel slug longitudinally expands the outer periphery of the gel slug and couples the gel slug to the cap ring 10510 through compression molding that presses the gel slug against the inner cylindrical wall of the cap ring 10510. The compressed gel slug and cap ring 10510 is then heated to a temperature sufficient for the polystyrene in the gel and the polymer of the cap ring 10510 to form a bond therebetween. Molding the gel slug separately from the cap ring 10510 and then thermally bonding the gel slug to the cap ring is particularly useful in embodiments where the cap ring 10510 includes a material having a lower melting point than the gel MGT. In such situations, the gel slug can be molded separately and thermally bonded to the cap ring 10510 without melting the cap ring 10510.

  Some embodiments of the pad may be rubber, synthetic rubber, silicone, ethylene propylene diene monomer (EPDM), ethylene propylene copolymer (EP rubber), polyisoprene, polybutadiene, polyurethane, instead of or in addition to gel, Another flexible elastomer material, such as at least one of butadiene styrene, ethylene vinyl acetate (Eva), polychloroprene (Neoprene®), perfluoroelastomer (Kalrez®), and the like. Some embodiments include a composite such as a multilayer structure and / or a plurality of sheets of one or more polymeric materials. For example, some embodiments include outer surfaces and / or sheets that provide desirable functions such as mechanical strength, abrasion resistance, antibacterial properties, and the like. Various embodiments of the pad or prosthetic wall allow the instrument or trocar extending therethrough to be translated and / or pivoted.

  Embodiments of a method for retracting an incision or body opening using the retractor 6100 have already been described in detail. In this manner, the retractor outer ring 6120 with a portion of the sleeve 6130 wound substantially contacts the outer surface of the body wall. The gel cap 10510 is then coupled to the retractor outer ring 6120 to seal the opening between the body cavity and the extracorporeal region, allowing the surgeon to inflate the body cavity.

  As described above, the embodiment of the gel cap 10500 does not include a pre-formed access channel within the gel pad 10530. In use, the instrument can be inserted directly through the gel pad 10530, thereby forming an access channel through the gel pad 10530. Since the gel provides a hermetic seal around instruments of various shapes and sizes, the individual access channels formed within the gel cap form an instrument seal when there is an instrument passing through the access channel. When the instrument is removed from the gel pad 10530, the channel formed in the gel pad by the instrument closes to form a zero seal.

  However, some embodiments of the gel pad 10530 are damaged by repeated insertion and removal of the instrument through the access channel, such as crushing, peeling, etc. This damage can degrade the instrument seal or zero seal of the affected access channel. Damaged gel fragments or particles can also enter the body cavity. Thus, some embodiments, particularly where the access channel faces repeated instrumentation operations such as insertion, removal, advancement, retraction, rotation, and / or other operations, may include access devices such as trocars inserted through the gel pad 10530. Used for instrument access. Inserting individual trocars through the gel pad 10530 allows the introduction, removal and / or manipulation of instruments through the trocar without damaging the gel. Typically, during surgery, the trocar itself is not widely manipulated so that the access channel through which the trocar passes is not damaged, thereby maintaining the integrity of the gel pad 10530. Trocar embodiments are designed to withstand a wide range of instrument operations without causing problems under normal conditions.

  Since the gel cap 10500 does not include an access channel from the start, the surgeon is free to determine the placement of the instrument through the gel cap 10500. Further, the surgeon can flexibly place and reposition the ports within the region of the gel cap 10500 without restriction, and can select different trocar sizes for different clinical diagnoses. Since the gel cap 10500 is removable, a large specimen can be removed. Once removed, the gel cap 10500 can rejoin the retractor outer ring 6120, which restores the seal and allows the surgeon to reseal the body cavity.

  In addition, the gel embodiments can be deformed without losing physical integrity, while having a substantially airtight instrument seal with any instrument extending through the gel, and any access channel without an instrument extending through the gel. For holding an airtight zero seal. Thus, the embodiment of the gel cap 10500 allows the instrument passing through the gel pad 10530 to “float” or obtain a degree of freedom in translation or position, and angularly or pivotally. This floating allows the instrument to move relative to the cap ring 10510 and other instruments. In contrast, in other single or limited port systems, the instrument cannot float in one or both translationally or angularly.

  FIG. 11A is a plan view of an embodiment of a gel cap 11500 that includes a plurality of access ports, seals or seal valves disposed within the gel pad. FIG. 11B is a perspective plan view of the gel cap 11500 mounted on the retractor. FIG. 11C is a perspective bottom view of the gel cap 11500 mounted on the retractor. The gel cap 11500 includes a cap ring 11510 and a gel pad 11530 that are roughly similar to the cap ring and gel pad of the embodiments described above.

  The gel cap 11500 further includes a plurality of access ports 11540, at least a portion of which is disposed or embedded within the gel pad 11530. In the illustrated embodiment, the access port 11540 has a low profile, i.e., protrudes above and / or minimally above the proximal surface of the gel pad 11530 and / or below the distal surface of the gel pad 11530. Does not protrude. Thus, the length of the access port 11540 is similar to the thickness of the gel pad 11530, and the length of a typical trocar inserted into the gel pad 11530, including a seal assembly located above the gel pad 10530 and a cannula extending through the gel pad 11530. Shorter than that. The reduced length of the access port 11540 increases the angular or pivotal movement of the instrument extending through the access port 11540 and allows the use of curved and / or square instruments. In the illustrated embodiment, the access port 11540 is substantially permanent with the gel cap 11500 in use, ie it cannot be removed. A trocar can also be inserted through the gel pad 11530 if additional ports are desired.

  The individual ports 11540 are disposed distally of the longitudinal axis extending from the proximal side of the gel pad 11530 to the distal side, a first seal 11542 disposed on the proximal side of the gel pad 11530, and the first seal 11542. And a second seal 11544. Each port or seal 11540 has an aperture that penetrates the gel pad 11530 and coincides with the longitudinal axis. In the illustrated embodiment, the first seal 11542 forms an instrument seal with an instrument extending through the first seal, and the second seal 11544 forms a zero seal when there is no instrument extending through the second seal.

  In the illustrated embodiment, the first seal 11542 includes a septum seal. Each septum seal includes an aperture 11546 through the septum seal that is slightly smaller than the cross-section of the smallest instrument passed through the septum seal. The septum seal aperture 11546 is substantially aligned with the aperture through the gel pad and the longitudinal axis of the port 11540. As the instrument is inserted through the septum seal aperture 11546, the aperture 11546 expands to engage the outer surface of the instrument, thereby forming a seal with the outer surface. The septum seal includes an elastomeric material that biases the aperture against the instrument being inserted. One skilled in the art will appreciate that other types of instrument seals are used in other embodiments.

  In the illustrated embodiment, the second seal 11544 includes a double duckbill valve that functions as a zero closure seal that provides a zero seal when no instrument is inserted. One skilled in the art will appreciate that the second seal includes other types of seals such as duckbill valves, flap valves, and the like. Double duckbill valves are made of elastomeric material. In some embodiments, each of the first seal 11542 and the second seal 11544 is made of rubber, synthetic rubber, silicon, ethylene propylene diene monomer (EPDM), ethylene propylene copolymer (EP rubber), polyisoprene, polybutadiene, Elastomer materials such as at least one of polyurethane, butadiene styrene, ethylene vinyl acetate (Eva), polychloroprene (Neoprene®), perfluoroelastomer (Kalrez®) and the like are independently included.

  Thus, in use, the septum seal provides an instrument seal if there is an instrument inserted through the seal, and the duckbill valve provides a zero seal if there is no instrument inserted through the seal. The illustrated embodiment includes different sized ports or seals 11540 within the gel pad. The individual size sealing port 11540 corresponds to a different range of instrument sizes inserted through this port. Typically, the size of the port is given as the diameter of the largest instrument that the port accommodates, such as 5 mm, 11 mm, or 12 mm. FIGS. 11D, 11E, and 11F illustrate a thin device 11550a and a thick device 11550b inserted through the smaller port 11540a and the larger port 11540b of the embodiment of the gel cap 11500 shown in FIGS. 11A-11C. They are a perspective plan view, a perspective bottom view, and a side view, respectively.

  FIG. 11G is a top perspective view of an embodiment of a gel cap 11500 that further includes a fixed port location, eg, for a camera or laparoscope. Fixed port 11560 includes a locking mechanism 11562 that holds the position of the camera or laparoscope inserted through fixed port 11560. In some embodiments, one of the ports 11540 further includes a stopcock and / or gas fitting that is used as a gas inlet and / or outlet port for delivering gas to the body cavity, depressurizing and / or exhausting. Including. In some embodiments, a gas inlet / outlet port is disposed on the cap ring 11510.

  FIG. 12 is a cutaway perspective view of an embodiment of an access device system 12000 that includes a retractor 12100 and a cap or cover 12500, similar to the retractor and gel cap embodiments described above. The retractor 12100 includes an inner ring 12110, an outer ring 12120, and a sleeve 12130 extending between the inner ring 12110 and the outer ring 12120. In the illustrated embodiment, the cap 12500 is a gel cap that includes a proximal side, a distal side, a cap ring 12510, and a gel pad 12530. In the illustrated embodiment, the cap ring 12510 includes a tubular ring sized to receive the retractor outer ring 12120 therein. The distal side of the cap ring 12510 includes an annular slot 12520 that is sufficiently radially deformable to allow the outer ring 12120 to pass reversibly. Thus, the illustrated cap ring 12510 embodiment secures the cap 12500 to the outer ring 12120 with a snap fit or friction fit.

  FIG. 13 is an exploded view of an embodiment of a trocar 13800 and optional obturator 13900 that are components of some embodiments of an access device system. In the illustrated embodiment, obturator 13900 includes a sharp piercing tip 13910. In embodiments where the trocar 13800 and obturator 13900 are inserted through the gel pad 10530 rather than through the body wall, as described above, the gel pad 10530 acts as an artificial body wall spaced from the underlying tissue so that the underlying tissue is The possibility of damage due to contact with the tip 13910 is reduced. In other embodiments, the obturator tip 13910 has another shape, such as non-pointed and / or bladeless, which can damage other parts of the access system, such as the retractor sheath of the retractor Is reduced.

  Trocar 13800 includes a proximal end, a distal end, and a longitudinal axis. Trocar 13800 includes cannula 13810 extending along the longitudinal axis. A trocar seal 13820 is disposed at the proximal end of the cannula 13810. A retainer 13830 is disposed at the distal end or tip of the cannula 13810. In the illustrated embodiment, the distal end or tip of the cannula 13810 is not angled. Other embodiments include the distal end or tip of an angled cannula 13810. The illustrated trocar 13800 embodiment does not include an insufflation gas inlet. Thus, the trocar 13800 is typically used in surgery where air is not delivered to the body cavity or is delivered via another device. US patent application Ser. No. 11 / 677,994, filed Feb. 22, 2007, discloses other embodiments of trocars, the disclosure of which is incorporated herein by reference.

  Cannula 13810 includes an elongated tubular cannula body 13812 that is dimensioned to receive an instrument or instruments received via elongated tubular cannula body 13812. In the illustrated embodiment, the cannula body 13812 is a generally cylindrical tube that extends through the gel pad 10530 in use. In the illustrated embodiment, cannula body 13812 extends from the proximal end of cannula 13810 having a larger outer diameter than cannula body 13812 with trocar seal 13820 coupled thereto.

  In some embodiments, the cannula 13810 is relatively short because the cannula body 13812 need only traverse the known consistent thickness gel pad 10530 (FIG. 10A) and not the body wall. Thus, in some embodiments of the cannula body 13812, the length is at most about 2 times, about 1.5 times, about 1.2 times, or about 1.1 times the thickness of the gel pad. In some embodiments, the cannula body 13812 is no more than about 20 mm, about 10 mm, or about 5 mm longer than the thickness of the gel pad. In some embodiments, the gel pad is approximately the same length as the thickness of the cannula body 13812. In other embodiments, the cannula body 13812 has different lengths, such as those typical for cannulas used to cross body walls. Due to the short length of the cannula body, the angular freedom of instruments passing through the cannula body is increased. Shorter cannula body embodiments also accommodate curved instruments. Cannula 13810 includes any suitable biocompatible material. In some embodiments, the cannula 13810 includes a flexible material.

  The illustrated trocar seal 13820 includes an instrument or septum seal 13822 and a zero seal 13824. Instrument seal 13822 seals the instrument passing through, thereby holding the pneumoperitoneum. Zero seal 13824 provides a seal when no instrument passes through trocar seal 13820. Instrument seal 13822 and zero seal 13824 are received within a housing 13826 disposed at the proximal end of cannula 13810 and secured within the housing by seal cover 13828.

  At or near the distal end of the cannula 13810, a retainer 13830 is disposed. In the illustrated embodiment, the distal end of the cannula 13810 is roughly perpendicular to the longitudinal axis of the cannula, i.e., not angled. Other embodiments include an angled distal end or tip. In some embodiments, the retainer 13830 and cannula 13810 are integrated, and in some embodiments, the retainer 13830 and cannula 13810 are not integrated. In the illustrated embodiment, the proximal end of the retainer 13830 includes a flat and vertical longitudinal flange 13833, while the distal end is tapered and narrows toward the distal end of the cannula 13810. . Flange 13832 reduces the likelihood that trocar 13800 will be accidentally or unintentionally removed from the gel pad. Some embodiments of the proximal surface of the flange 13832 include additional fixation features, such as barbs, spikes, ridges, texturing, etc., configured to penetrate or engage the distal surface of the gel pad 10530. including. In some embodiments, the diameter of the flange 13832 is about 1.5 to about 2.5 times, or about 2 to about 2.2 times wider than the outer diameter of the cannula body 13812. Some embodiments of the trocar 13800 are 5 mm trocars, where the outer diameter of the cannula body 13812 is from about 7 mm to about 8 mm.

  The tapered end of the retainer 13830 facilitates insertion of the trocar 13800 through the gel pad when assembled with the obturator 13900 that extends by itself or through the trocar 13800. For example, in some embodiments, the retainer 13830 is inserted through a pre-formed opening in the gel pad 10530. As described above, the gel material embodiment of the gel pad 10530 has a high elongation value, so that the retainer 13830 can be inserted through a relatively small opening in the gel pad 10530, yet further unintentionally removed as described above. Resist.

  In some embodiments in which the retainer 13830 and cannula 13810 are not integrated, i.e., separate parts, the retainer 13830 is secured to the cannula 13810 after the cannula 13810 is inserted through the gel pad. In some embodiments, cannula 13810 and retainer 13830 are mechanically secured using, for example, latches, threads, clips, lock rings, ratchets, and the like. In some embodiments, cannula 13810 and retainer 13830 are secured with an adhesive. In some embodiments, the position of the retainer 13830 can be adjusted to accommodate, for example, different thickness gel pads. In some embodiments, cannula 13810 and / or retainer 13830 are secured to the gel pad with, for example, an adhesive.

  FIG. 14A is a side view of another embodiment of a trocar 14800 suitable as part of the single port surgical access system described above, including, for example, a gel pad 10530 and a retractor. Some embodiments of the access system include a plurality of trocars 14800. Trocar 14800 is generally similar to trocar 13800 described above, and includes a cannula 14810, trocar seal assembly 14820, and retainer 14830 that are generally similar to the corresponding features described above. The illustrated trocar 14800 embodiment further includes a bolster 14840 and a locking component 14850. As will become apparent from the description below, the illustrated embodiment of the cannula 14810 is also referred to as a “fixed cannula”.

  In the illustrated embodiment, the bolster 14840 includes a torus or ring. Cannula body 14812 extends through an opening in bolster 14840. The diameter of the opening of the bolster 14840 is sufficiently larger than the outer diameter of the cannula body 14812 to allow free movement along the cannula body 14812. As described in further detail below, the illustrated embodiment of bolster 14840 includes a deformable material such as a polymer resin and / or an elastomer. Examples of suitable materials include rubber, natural rubber, synthetic rubber, polyisoprene, styrene-butadiene rubber, silicone rubber, ethylene-propylene copolymer, ethylene-propylene-diene monomer rubber, polybutadiene, polychloroprene, polyurethane and the like. . Some embodiments of bolster 14840 include a lubricating layer or coating in the area or region that contacts cannula 14810, which facilitates movement along cannula 14810.

  The outer diameter of some embodiments of the bolster 14840 is about 0.8 to 2 times, or about 1 to about 1.5 times the diameter of the flange 14832 of the retainer 14830. The thickness of the bolster is about 3 mm (0.12 inches) to about 10 mm (0.4 inches), or about 4 mm (0.16 inches) to about 6 mm (0.24 inches). In some embodiments, the bolster distal surface 14844 is concave to provide additional clamping or securing force to the gel pad 10530 and to accommodate different and / or non-uniform thickness gel pads 10530. The specific dimensions of the bolster 14830 are selected based on the characteristics of the bolster material and gel material and the dimensions of the cannula body 14812, locking component 14850, and gel pad 10530.

  Locking component 14850 is disposed proximate to retainer 14830 on cannula body 14812 and includes a lip 14852 proximate enlarged portion 14854. The lip 14852 extends radially from the cannula body 14812 and its diameter exceeds the diameter of the opening of the bolster 14840. The elastomeric material of bolster 14840 can prompt bolster 14840 over lip 14852 and beyond lip 14852. In the illustrated embodiment, the lip 14852 includes a ratchet dimensioned to allow the bolster 14840 to easily slide distally and to prevent the bolster 14840 from sliding proximally. In the illustrated embodiment, the lip 14852 is a continuous structure surrounding the cannula body 14812. In other embodiments, the lip 14852 includes a plurality of structures disposed around the cannula body 14812.

  The enlarged portion 14854 is generally cylindrical and has a diameter that is approximately the same or slightly larger than the diameter of the opening of the bolster 14840 so that the bolster 14840 frictionally engages the enlarged portion 14854. In the illustrated embodiment, the enlarged portion 14854 is longer than the thickness of the bolster 14840. In the illustrated embodiment, the enlarged portion 14854 does not extend or contact the flange 14830 of the retainer 14830, thereby reducing the surface area of the proximal surface of the enlarged portion 14854, thereby improving the removal resistance of the enlarged portion 14854. In other embodiments, the enlarged portion 14854 extends to the retainer 14830. Other embodiments do not include an enlarged portion.

  The distance between the distal end of the lip 14852 and the proximal surface of the flange 14832 is equal to or slightly less than the total thickness of the bolster 14840 and the gel pad 10530. In some embodiments, the gel pad has a thickness of about 5 mm (about 0.4 inches) to about 30 mm (about 1.2 inches), or about 13 mm (about 0.5 inches) to about 25 mm (about 1 inch). is there.

  Trocar 14800 has at least two configurations, a first or insertion configuration shown in FIG. 14A and a second or fixed configuration shown in FIG. 14B.

  In an embodiment of a method using trocar 14800, trocar 14800 is placed in an insertion configuration and initially bolster 14840 is positioned on cannula body 14812. Trocar 14800 is placed in the prosthetic wall before and / or after the prosthetic wall is connected to the patient's body.

  In the embodiment shown in FIG. 14A, a bolster 14840 is located at the proximal end of the cannula body 14812, where the bolster 14840 is an enlarged portion of the cannula 14810 to which the seal assembly 14820 is coupled, a bell-shaped cannula. Frictionally engages the distal portion of portion 14814.

  The distal end of trocar 14800 is placed on a prosthetic wall, such as gel pad 10530, after which retainer 14830 is inserted through the prosthetic wall. In some embodiments, at the proximal end of the trocar, obturator 13900 (FIG. 13) is first inserted through seal assembly 14820 with tip 13910 previously extended from the distal end of the obturator. In other embodiments, another device is first used to form an opening in the prosthesis wall. In other embodiments, the distal end of trocar 14800 is forced through the prosthesis wall to form an opening in this process.

  The trocar 14800 is then changed to the fixed configuration shown in FIG. 14B by sliding the bolster 14840 below the cannula body 14812 and over the lip 14852 onto the enlarged portion 14852. In the illustrated configuration, the prosthetic wall is captured and compressed between the retainer flange 14830 and the bolster 14840. The lip 14852 locks or locks the trocar 14800 to the prosthesis wall by locking the bolster 14840 in place and preventing the bolster 14840 from moving proximally.

  In the fixed configuration, the trocar 14800 is fixed relative to a local portion of the wall of the prosthesis body being engaged. However, as noted above, the artificial wall embodiment exhibits high elongation. Thus, the trocar 14800 can translate and / or pivot relative to its original position and orientation by deforming the artificial wall.

  In embodiments using obturator 13910, the obturator is retracted. Trocar 14800 serves as an access port for one or more instruments during a surgical procedure.

  If desired, the trocar 14800 is removed from the artificial body wall, for example, by first removing the bolster 14840 from the locking component 14850 and then pulling the retainer 14830 away from the artificial body wall. In some embodiments, the trocar 14800 and the prosthetic wall are not removed and are arranged as a unit. In some embodiments, it is not possible to remove the bolster 14840 from the locking component 14850.

  FIG. 15 is a side view of another embodiment of a holding trocar 15000 that is generally similar to the embodiment shown in FIGS. 14A and 14B and described above. The trocar 15000 is disposed at the distal end of the cannula 15810, an elongated tubular cannula 15810 including a proximal end and a distal end and a cannula body 15812, a seal assembly 15820 coupled to the proximal end of the cannula 15810 Retainer 15830, bolster 14840 through which cannula body 15812 extends, and locking component 15850 disposed proximate to retainer 15830 on the cannula body.

  In the illustrated embodiment, the locking component 15850 includes an enlarged portion 15854 on which a thread 15852 is disposed. Bolster 15840 includes matching threads. As a result, the bolster 15840 can be engaged with the locking component 15850 so as to be screwed together. This threaded connection also allows adjustment of the relative position of the bolster 15840 and the retainer flange 15832 in the fixed configuration of the trocar 15800, thereby enabling fixation to non-uniform and / or different thickness artificial body walls.

  FIG. 16A is a side view of another embodiment of a trocar 16800. FIG. FIG. 16B is a perspective view of an embodiment of a bolster 16840 that can be used with trocar 16800. FIG. The combination of trocar 16800 and bolster 16840 is roughly similar to the trocar embodiment shown in FIGS. 14A, 14B, and 15. The trocar 16800 is disposed at the distal end of the cannula 16810, an elongated tubular fixed cannula 16810 including a proximal end and a distal end and a cannula body 16812, a seal assembly 16820 coupled to the proximal end of the cannula 16810. And a locking component 16850 disposed proximate to the retainer 16830 on the cannula body.

  In the illustrated embodiment, the locking component 16850 includes an enlarged portion 16854 where a plurality of annular rings 16852 extending radially from the cannula body 16812 are provided to define a plurality of annular slots 16856. In the illustrated embodiment, the proximal end of each ring 16856 is beveled, but some embodiments do not include a beveled end.

  FIG. 16B shows an embodiment of a clip-shaped bolster 16840 that includes a flat body 16842 provided with a cutout 16844 that includes a semi-circular portion. Cutout 16844 is sized to engage slot 16856. The thickness of the flat body 16842 at the cutout 16844 is also sized to engage the slot 16856. The bolster 16840 includes a grip 16846 that extends vertically from the flat body 16842, which provides a user grip for installing and / or adjusting the bolster 16840. In other embodiments, the cutout 16844 has another shape, such as a polygon, a rectangle, or a portion of a hexagon.

  In use, the trocar retainer 16830 is inserted through the prosthesis wall as described above and secured internally by engaging the bolster 16840 within a slot 16856 that provides the desired securing force. The degree of fixation can be adjusted by selecting different slots.

  In some embodiments, bolster cutouts 16844 engage multiple slots to provide additional stability in a fixed configuration. Other embodiments include a bolster through which cannula body 16812 extends, similar to the embodiments described above. In some of these embodiments, the locking component 16850 serves as a ratchet. The bolster increases the adjustment force by including one or more pawls that are optionally releasable.

  FIG. 17A shows a side view of an embodiment of a trocar 17800 that includes a fixed cannula, and FIG. 17B is a perspective view of an embodiment of a bolster. The embodiment shown in FIGS. 17A and 17B is generally similar to the trocar embodiment shown in FIGS. 14A-16B and described above.

  Trocar 17800 includes an elongated tubular stationary cannula 17810 including a proximal end and a distal end and a cannula body 17812, a seal assembly 17820 coupled to the proximal end of cannula 17810, and a retainer disposed on cannula body 17812. 17830 and a locking component 17850 disposed at the distal end of cannula 17810. The embodiment of the illustrated trocar 17800 is similar to the embodiment shown in FIG. 16A, but the positions of the retainer 17830 and the locking component 17850 are reversed. In the illustrated embodiment, the retainer flange 17832 faces distally.

  Locking component 17850 includes an enlarged portion 17854 that includes a plurality of annular rings 17852 extending radially from cannula body 17812, where a plurality of annular slots 17856 are defined.

  FIG. 17B shows an embodiment of a clip-shaped bolster 17840 that includes a flat body 17842 provided with a cutout 17844 that includes a semi-circular portion. Cutout 17844 is sized to engage slot 17856 in the locking component. The thickness of the flat 17842 of the cutout 17844 is also sized to engage the slot 17856. The illustrated bolster embodiment does not include a grip, while other embodiments include a grip.

  In some embodiments using the embodiment of the trocar 17800, the prosthetic wall is coupled to the patient's body after the cannula 17810 is secured to the prosthetic wall. For example, in some embodiments, the gel cap 10500 is coupled to the retractor 7100 (FIG. 7) after securing one or more trocars 17800 on the gel pad 10530 (FIG. 10A) of the gel cap 10500.

  While several embodiments have been shown and described in detail with reference to exemplary embodiments, those skilled in the art will recognize that the form and details may be practiced without departing from the spirit and scope as defined by the following claims. It will be understood that various changes can be made.

14800 Trocar 14810 Cannula 14812 Cannula body 14814 Bell-shaped part 14820 Trocar seal assembly 14830 Retainer 14842 Franc 14840 Bolster 14844 Distal face 14850 Locking part 14852 Lip 14854 Enlarged part

Claims (30)

A surgical access system comprising a trocar, wherein the trocar comprises
A fixed cannula including a tubular cannula body including a proximal end, a distal end, and a longitudinal axis extending from the proximal end to the distal end; and a cannula wall defining a cannula lumen;
A seal assembly coupled to the proximal end of the cannula body;
A retainer extending from the cannula body;
A locking component disposed on the cannula body and spaced from the retainer;
A bolster engageable with the locking part;
The trocar has an insertion configuration in which the bolster is not engaged with the locking component, and a fixed configuration in which the bolster is engaged with the locking component, wherein the retainer and the A bolster is sized and configured to secure the cannula to the prosthesis wall by capturing the prosthesis wall therebetween.
Surgical access system characterized by that. The trocar is a 5 mm trocar;
The surgical access system according to claim 1. The cannula includes at least one of polycarbonate and polyester;
The surgical access system according to claim 1. The seal assembly includes a diaphragm valve and a duckbill valve;
The surgical access system according to claim 1. The retainer is disposed at the distal end of the cannula body and the locking component is proximate to the retainer;
The surgical access system according to claim 1. The retainer includes a radially extending flange;
The surgical access system according to claim 1. A diameter of the retainer flange is about 1.5 to about 2.5 times larger than an outer diameter of the cannula body;
The surgical access system according to claim 6. The distal end of the retainer is tapered;
The surgical access system according to claim 1. The locking part includes an enlarged portion;
The surgical access system according to claim 1. The locking part includes a circumferential lip;
The surgical access system according to claim 1. The locking component includes a thread;
The surgical access system according to claim 1. The locking component includes a plurality of circumferential slots;
The surgical access system according to claim 1. The locking part includes a ratchet;
The surgical access system according to claim 1. The bolster comprises an elastomeric material;
The surgical access system according to claim 1. The bolster includes a torus with an opening through which the cannula body extends;
The surgical access system according to claim 1. The bolster includes threads,
The surgical access system according to claim 1. The bolster includes at least one pawl dimensioned to engage a ratchet on the locking component;
The surgical access system according to claim 1. The bolster includes a clip dimensioned to engage the locking component;
The surgical access system according to claim 1. The diameter of the bolster is about 0.8 to about twice the diameter of the flange;
The surgical access system according to claim 1. In the fixed configuration, the locking component resists removal of the bolster,
The surgical access system according to claim 1. In the fixed configuration, a distance between the retainer and the bolster is adjustable.
The surgical access system according to claim 1. Further comprising an obturator,
The surgical access system according to claim 1. Further comprising an artificial wall,
The surgical access system according to claim 1. The artificial wall includes a gel pad;
24. The surgical access system of claim 23. The gel pad is coupled to a cap ring to define a gel cap;
25. The surgical access system of claim 24. An adjustable retractor that can be coupled to the gel cap;
26. The surgical access system of claim 25. A method of securing a trocar including a fixation cannula to an artificial body wall,
Switching the trocar of claim 1 to the insertion configuration;
Inserting the distal end of the cannula body through an artificial body wall;
Capturing the artificial body wall between the retainer and the bolster by switching the trocar to the fixed configuration by engaging the bolster with the locking component;
A method comprising the steps of: Further comprising inserting an obturator through the trocar;
28. The method of claim 27. Adjusting the distance between the bolster and the retainer in the fixed configuration;
28. The method of claim 27. A surgical access system comprising:
Adjustable retractor, gel cap, trocar,
With
The retractor is
A proximal ring, a distal ring, and a flexible tubular retractor sheath extending between the proximal ring and the distal ring, the proximal ring rotating about an annular axis of the ring. The length of the retracting sheath is adjusted between the proximal ring and the distal ring,
The gel cap is
A cap ring engageable with the proximal ring and a gel pad coupled to the cap ring;
The trocar is
A stationary cannula including a tubular cannula body including a proximal end, a distal end, a longitudinal axis extending from the proximal end to the distal end, and a cannula wall defining a cannula lumen;
A seal assembly coupled to the proximal end of the cannula body;
A retainer extending from the cannula body;
A locking component disposed on the cannula body and spaced from the retainer;
A bolster engageable with the locking part;
Including
The trocar has an insertion configuration in which the bolster is not engaged with the locking component, and a fixed configuration in which the bolster is engaged with the locking component. In the fixed configuration, the retainer and the bolster include: Sized and configured to secure the cannula to the gel pad by capturing the gel pad therebetween.
Surgical access system characterized by that.

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